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Perioperative Major Adverse Cardiovascular and Cerebrovascular Events Associated With Noncardiac Surgery
Nathaniel R Smilowitz1, Navdeep Gupta2, Harish Ramakrishna3
1Division of Cardiology, Department of Medicine, New York University School of Medicine, New York.
Insights
Major adverse cardiovascular and cerebrovascular events (MACCE) decreased overall after noncardiac surgery, but perioperative ischemic stroke rates increased. Further research is needed to improve patient cardiovascular care.
Area of Science:
- Cardiovascular Medicine
- Surgical Outcomes
- Health Services Research
Background:
- Major adverse cardiovascular and cerebrovascular events (MACCE) significantly contribute to morbidity and mortality after noncardiac surgery.
- Understanding national trends in perioperative cardiovascular outcomes is crucial for improving patient care.
Purpose of the Study:
- To analyze national trends in perioperative cardiovascular outcomes and mortality following major noncardiac surgery.
- To identify specific surgical subtypes associated with increased cardiovascular event risk.
Main Methods:
- Utilized the National Inpatient Sample database for hospitalizations between 2004 and 2013.
- Evaluated perioperative MACCE, including in-hospital death, acute myocardial infarction (AMI), and acute ischemic stroke.
Main Results:
- Over 10.5 million hospitalizations for major noncardiac surgery were analyzed.
- Overall MACCE incidence decreased from 3.1% to 2.6% between 2004 and 2013.
- Perioperative ischemic stroke rates increased significantly, while death and AMI rates declined.
Conclusions:
- Perioperative MACCE affects 1 in 33 hospitalizations for noncardiac surgery.
- Despite overall improvements, the rise in perioperative ischemic stroke necessitates enhanced cardiovascular care strategies.
- Targeted interventions are required to mitigate cardiovascular risks in patients undergoing noncardiac surgery.
Importance:
Major adverse cardiovascular and cerebrovascular events (MACCE) are a significant source of perioperative morbidity and mortality following noncardiac surgery.
Objective:
To evaluate national trends in perioperative cardiovascular outcomes and mortality after major noncardiac surgery and to identify surgical subtypes associated with cardiovascular events using a large administrative database of United States hospital admissions.
Design, Setting, Participants:
Patients who underwent major noncardiac surgery from January 2004 to December 2013 were identified using the National Inpatient Sample.
Main Outcomes And Measures:
Perioperative MACCE (primary outcome), defined as in-hospital, all-cause death, acute myocardial infarction (AMI), or acute ischemic stroke, were evaluated over time.
Results:
Among 10 581 621 hospitalizations (mean [SD] patient age, 65.74 [12.32] years; 5 975 798 female patients 56.60%]) for major noncardiac surgery, perioperative MACCE occurred in 317 479 hospitalizations (3.0%), corresponding to an annual incidence of approximately 150 000 events after applying sample weights. Major adverse cardiovascular and cerebrovascular events occurred most frequently in patients undergoing vascular (7.7%), thoracic (6.5%), and transplant surgery (6.3%). Between 2004 and 2013, the frequency of MACCE declined from 3.1% to 2.6% (P for trend <.001; adjusted odds ratio [aOR], 0.95; 95% CI, 0.94-0.97) driven by a decline in frequency of perioperative death (aOR, 0.79; 95% CI, 0.77-0.81) and AMI (aOR, 0.87; 95% CI, 0.84-0.89) but an increase in perioperative ischemic stroke from 0.52% in 2004 to 0.77% in 2013 (P for trend <.001; aOR 1.79; CI 1.73-1.86).
Conclusions And Relevance:
Perioperative MACCE occurs in 1 of every 33 hospitalizations for noncardiac surgery. Despite reductions in the rate of death and AMI among patients undergoing major noncardiac surgery in the United States, perioperative ischemic stroke increased over time. Additional efforts are necessary to improve cardiovascular care in the perioperative period of patients undergoing noncardiac surgery.
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